Efficacy and safety of brolucizumab in age‐related macular degeneration: A systematic review of real‐world studies

Abstract

Intravitreally injected anti-vascular endothelial growth factor (anti-VEGF) agents are first-line treatment for neovascular age-related macular degeneration (nAMD).Phase 3 trials demonstrated non-inferiority of anti-VEGF therapy with brolucizumab compared with aflibercept in best corrected visual acuity (BCVA) gains, with superior anatomical outcomes after brolucizumab. The purpose of the review was to summarize real-world efficacy and safety data on brolucizumab in patients with nAMD. The review protocol was registered with PROSPERO (ID: CRD42021290530). We conducted systematic searches in Embase, Medline and key ophthalmology congress websites (19 October 2021). Original reports of efficacy and/or safety in patients receiving brolucizumab to treat nAMD in clinical practice were eligible. The descriptive summary includes reports describing at least 10 brolucizumab-treated eyes. In total, 2907 brolucizumab-treated eyes from 26 studies were included. Outcomes were available for treatment-naive eyes (six studies), eyes switched to brolucizumab from other anti-VEGFs (16 studies), and/ or treatment-naive and switch eyes combined (eight studies). Follow-up time points ranged from 4 weeks to 1 year post-brolucizumab initiation. For BCVA, significant improvements compared with brolucizumab initiation were reported in four of six studies in treatment-naive eyes (mean BCVA improvement, range: +3.7 to +11.9 EarlyTreatment Diabetic Retinopathy Study [ETDRS] letters) and in three of 12 studies in switch eyes (range: +9.0 to +15 ETDRS letters) (all p < 0.05); remaining studies reported no significant post-brolucizumab BCVA changes. For central subfield thickness (CST), improvements post-brolucizumab initiation were reported in all six studies in treatment-naive eyes (mean CST improvement, range: −113.4 to −150.1 μm) and in eight of 11 studies in switch eyes (range: −26 to −185.7 μm) (all p < 0.05). The 14 studies reporting on intraretinal, subretinal and/or total fluid observed improvements post-brolucizumab initiation. The four studies comparing treatment intervals observed extension of the interval between injections after switching to brolucizumab from other anti-VEGFs. Incidence of intraocular inflammation ranged from 0% to 19%. In conclusion, real-world efficacy and safety data concur with brolucizumab pivotal trials. Additionally, reduction of disease activity in anti-VEGF switch eyes was demonstrated by fluid reduction and/or visual acuity gain, along with prolongation of the interval between injections.

Faricimab in neovascular AMD: first report of real-world outcomes in an independent retina clinic

“…Furthermore, the these results are similar or better compared to those reported in CTs such as TENAYA and LUCERNE, which demonstrated noninferiority in mean change BCVA compared to a ibercept in nAMD patients (15). Matsumoto et al also showed signi cant BCVA improvement one month after the rst injection of brolucizumab in nAMD patients (29), however, this IVT has been associated with ocular in ammation (30,31,32).…”

Faricimab in Neovascular AMD

“…Furthermore, the these results are similar or better compared to those reported in CTs such as TENAYA and LUCERNE, which demonstrated noninferiority in mean change BCVA compared to a ibercept in nAMD patients (15). Matsumoto et al also showed signi cant BCVA improvement one month after the rst injection of brolucizumab in nAMD patients (29), however, this IVT has been associated with ocular in ammation (30,31,32).…”

Brolucizumab in Pretreated Neovascular Age-Related Macular Degeneration: Case Series, Systematic Review, and Meta-Analysis

“…Reasons to switch to brolucizumab were persistent disease activity with intra- and/or subretinal fluid and/or a high treatment demand with other anti-VEGF agents. This represents a highly specific but relevantly large subgroup of patients with nAMD [ 7 ] and demands separate analysis in contrast to pooled samples with treatment-naïve eyes, which have been widely published in both case series and meta-analyses [ 23 ]. From two prospective clinical trials addressing the same questions, one was aborted after one year, and another faced relevant recruiting issues [ 16 , 17 ].…”